Study Questions Whether Revision TJA Pre-Op Prep Time Is Adequately Valued
For Immediate Release
November 14, 2021
Dallas – A study presented at the 2021 AAHKS Annual Meeting aimed to quantify pre-operative work (POW) required for revision total joint arthroplasty (RevTJA) in preparation for the procedure’s removal from the Centers for Medicare and Medicaid Services’ in-patient only list in 2024. Determining the clinical effort associated with preparing for this surgery will help maintain the appropriate value for pre-operative work.
Lead author Samantha Mohler, MS, and co-authors Jeffrey B. Stambough, MD, Ashleigh Kathiresan, MEd, C. Lowry Barnes, MD, Simon C. Mears, MD, PhD, and Benjamin M. Stronach, MD, MS, retrospectively analyzed electronic medical record (EMR) activity for 100 hip and 100 knee RevTJAs. They concentrated on the surgical team’s work during the time between deciding to do surgery and the day prior to surgery, comparing results based on age, gender, insurance, and health literacy.
Researchers determined the average POW time period was 57.5 days, and total POW was 97.7 minutes. Surgeon work accounted for 10.5 minutes, while nurses spent 29.9 minutes, physician extenders 22.1 minutes, and office staff 34.1 minutes. Most work involved obtaining records, medication review, order sets, patient communication, and prior authorization. There was no difference in total POW based on procedure, age, gender, insurance, and health literacy.
In conclusion, the study found that RevTJA requires substantial preoperative time from the whole surgical team. Further, EMR audit logs only capture the bare minimum time required to prepare a patient for RevTJA, which may not include surgical planning outside the EMR. Researchers recommend more research be done prior to removing RevTJA as an inpatient-only procedure to ensure fair valuation of the surgical team’s effort.
Abstract:
A study presented at the 2021 AAHKS Annual Meeting aimed to quantify pre-operative work (POW) required for revision total joint arthroplasty (RevTJA) in preparation for the procedure’s removal from the Centers for Medicare and Medicaid Services’ in-patient only list in 2024. Determining the clinical effort associated with preparing for this surgery will help maintain the appropriate value for pre-operative work.
Lead author Samantha Mohler, MS, and co-authors Jeffrey B. Stambough, MD, Ashleigh Kathiresan, MEd, C. Lowry Barnes, MD, Simon C. Mears, MD, PhD, and Benjamin M. Stronach, MD, MS, retrospectively analyzed electronic medical record (EMR) activity for 100 hip and 100 knee RevTJAs. They concentrated on the surgical team’s work during the time between deciding to do surgery and the day prior to surgery, comparing results based on age, gender, insurance, and health literacy.
Researchers determined the average POW time period was 57.5 days, and total POW was 97.7 minutes. Surgeon work accounted for 10.5 minutes, while nurses spent 29.9 minutes, physician extenders 22.1 minutes, and office staff 34.1 minutes. Most work involved obtaining records, medication review, order sets, patient communication, and prior authorization. There was no difference in total POW based on procedure, age, gender, insurance, and health literacy.
In conclusion, the study found that RevTJA requires substantial preoperative time from the whole surgical team. Further, EMR audit logs only capture the bare minimum time required to prepare a patient for RevTJA, which may not include surgical planning outside the EMR. Researchers recommend more research be done prior to removing RevTJA as an inpatient-only procedure to ensure fair valuation of the surgical team’s effort.
Abstract: https://meeting.aahks.org/wp-content/uploads/2021-FINAL-Printed-Program-Book-pages-71.pdf
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About the American Association of Hip and Knee Surgeons
Established in 1991, the mission of AAHKS is to advance hip and knee patient care through education and advocacy. AAHKS has a membership of over 4,000 surgeons and other hip and knee health care professionals.
